Aim: Hemodialysis vascular access stenosis remains a frequent complication and early detection is challenging and costly. The aim of this in-vitro study was to assess a new detection method based o...
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Aim: Hemodialysis vascular access stenosis remains a frequent complication and early detection is challenging and costly. The aim of this in-vitro study was to assess a new detection method based on analysis of the pulse pressure measured at the hemodialysis needle.Methods: A silicon model of a radio-cephalic arteriovenous fistula was built in a mock loop. Pressures were measured at the arterial hemodialysis needle and in the proximal feeding artery. Stenoses (50% and 25% diameter reduction) were created proximal to the anastomosis (proximal artery) and distal to the arterial needle (distal vein and proximal vein). The pulse pressure at the needle was divided by the pulse pressure at the feeding artery to obtain a dimensionless ratio, %PP. Experiments were conducted at different blood flow and heart rates to test this new index over a wide range of hemodynamic conditions. Results: In the control model (no stenosis); %PP was 20.3 ± 4.6. A proximal artery 50%-stenosis significantly decreased %PP to 7.7 ± 2.1 (P < 0.0001), while presence of 50%-stenosis in the distal (36.2 ± 2.1) and proximal (32.4 ± 2.2) vein lead to significantly higher values of %PP (both P < 0.0001). The results for a 25%-stenosis remains statistical significant (all P < 0.003), but absolute differences are reduced.Conclusion: This in-vitro study shows that the analysis of the pulse pressure at the dialysis needle is useful for early detection and localization of hemodialysis vascular access stenoses, independent of heart rate and blood flow rate. Before using the index in daily clinical practice, our new method should be validated and calibrated in a clinical study.

aAim: Hemodialysis vascular access stenosis remains a frequent complication and early detection is challenging and costly. The aim of this in-vitro study was to assess a new detection method based on analysis of the pulse pressure measured at the hemodialysis needle.Methods: A silicon model of a radio-cephalic arteriovenous fistula was built in a mock loop. Pressures were measured at the arterial hemodialysis needle and in the proximal feeding artery. Stenoses (50% and 25% diameter reduction) were created proximal to the anastomosis (proximal artery) and distal to the arterial needle (distal vein and proximal vein). The pulse pressure at the needle was divided by the pulse pressure at the feeding artery to obtain a dimensionless ratio, %PP. Experiments were conducted at different blood flow and heart rates to test this new index over a wide range of hemodynamic conditions. Results: In the control model (no stenosis); %PP was 20.3 ± 4.6. A proximal artery 50%-stenosis significantly decreased %PP to 7.7 ± 2.1 (P < 0.0001), while presence of 50%-stenosis in the distal (36.2 ± 2.1) and proximal (32.4 ± 2.2) vein lead to significantly higher values of %PP (both P < 0.0001). The results for a 25%-stenosis remains statistical significant (all P < 0.003), but absolute differences are reduced.Conclusion: This in-vitro study shows that the analysis of the pulse pressure at the dialysis needle is useful for early detection and localization of hemodialysis vascular access stenoses, independent of heart rate and blood flow rate. Before using the index in daily clinical practice, our new method should be validated and calibrated in a clinical study.

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